Syeda Batool Mazhar, Rehma Arshad.
Recurrent ovulation hemorrhage due to Factor V deficiency.
J Pak Inst Med Sci Jan ;15(1):884-5.

A 20 years old nulliparous lady, married since 1 year, presented with complaints of pelvic mass, lower abdominal pain and dysuria for 14 days. She was a known case of factor V deficiency since 6 years of age. She had past history of easy bruisability and prolonged bleeding after minor injuries and simple procedures like tooth extraction. There was no history one episode of haemarthrosis at 18 years of age. She had to undergo three laparotomies for recurrent acute abdomen, massive haemoperitoneum and hemorrhagic shock, first at the age of 18 years in March 2001, second in July 2001. She was subsequently advised to use combined oral contraceptive pills to prevent ovulation with which she complied for a year. She stopped combined oral contraceptive pills after marriage and again developed massive hemoperitoneum for which she had a third laparotomy. During each hospital stay she received multiple blood transfusions and infusions of fresh frozen plasma. There was no family history of bleeding disorders. Her parents are first cousins. On examination she had marked pallor and a pelvic mass of about 20 weeks size. Her Hb was 7.8g/dl, platelet count was 656000, plasma fibrinogen was 211 mg/dl, Prothrombin time was >30 seconds (control 13 seconds) and APTT was >1 minute (control 33 seconds). Her pelvic ultrasonography showed normal sized uterus and a right adenexal mass with internal echoes measuring about 69x77 mm. This mass was displacing the uterus anteriorly. As the presentation was subacute, so she was managed conservatively, 1 unit of blood was transfused and 7 units of fresh frozen plasma were given. She was strongly advised to use combined oral contraceptive pill regularly. At the time of discharge she was stable, her dysuria and pain was relieved without any analgesics. She was followed up fortnightly. She was symptomatically much better, her abdomen was softer and pelvic mass was reduced to 18 weeks size. Unfortunately she is again lost to follow up.

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